左旋布比卡因在可行走式分娩镇痛中的应用  

Levobupivacaine with fentanyl for walkable labor analgesia

作　　者：李宝珠[1] 黄东林[2] 关红曼[1] 年爱时[1] 于雪梅[1] 

机构地区：[1]大连医科大学第一临床学院麻醉科,辽宁大连116011 [2]大连市妇产医院麻醉科,辽宁大连116021

出　　处：《大连医科大学学报》2007年第6期560-562,共3页Journal of Dalian Medical University

摘　　要：[目的]观察0.1%的左旋布比卡因是否可完全避免对产妇下肢肌力的影响;如果0.1%左旋布比卡因的分娩镇痛效果不全,加入微量芬太尼是否可增强镇痛效果又不影响下肢肌力。[方法]60例符合条件的临产妇,按椎管内用药的不同随机分为IB组和IBF组。采用联合阻滞方法,蛛网膜下隙用药IB组是左旋布比卡因2.5 mg(2mL);IBF组是左旋布比卡因2.5 mg+芬太尼20μg(2 mL)。硬膜外导管接上微量泵,以12 mL/h的速度注入预先配制好的硬膜外药物,IB组药物为0.1%左旋布比卡因;IBF组为0.1%左旋布比卡因+1μg/mL的芬太尼。[结果]两组间年龄、体重、身高、胎龄、镇痛前宫口大小、血压、心率、血氧饱和度差异均无显著性意义,分娩情况及新生儿Apger’s评分差异也无显著性意义。LBF组VAS平均第一产程为2.5±1.0,第二产程为3.5±1.5;LB组VAS平均第一产程为5.5±1.0,第二产程为6.0±1.5,两组比较差异有显著性意义(P<0.05)。两组在各时段感觉阻滞范围、肌力方面呈共同变化趋势,无明显差异。搔痒发生率LBF组(16/30)明显高于LB(2/30)组(P<0.05)。[结论]采用联合阻滞方法,从蛛网膜下隙给予左旋布比卡因2.5 mg及芬太尼20μg,然后以12 mL/h的速度从硬膜外注入0.1%的左旋布比卡因加1μg/mL的芬太尼,能达到可行走式分娩镇痛。[ Objective ] Whether levobupivacaine 0.1% will avoid to block motor nerves. Whether it will increase the effect of analgesia when we add minim fentanyl in it. [ Methods] Sixty nulliparous parturient in labor were recruited to receive different medicine in intrathecal with combined spinal epidural. IB group used 2.5 mg levobupivacaine （2 mL） and IBF group used 2.5 mg levobupivacaine ＋ 20 μg fentanyl （2 mL） in subarachnoid. Then IB group used levobupivacaine 0.1% and IBF group used levobupivacaine 0.1% ＋ 1 μg/mL fentanyl with 12 mL/h in epidural. [ Results] Both groups were similar in terms of age, weight, height, cervical dilatation score, SBP and SpOE, There were no differences in the mode of delivery and apgar status between the groups. VAS （ visual analog scale） were significantly better in IB group 2.5 ± 1.0 （ first stage） and 3.5±1.5 （ second stage） than in IB group 5.5± 1.0（ first stage） and 6.0 ± 1.5 （second stage）. Purities were significantly higher in group IBF than in group IB （16/30 vs. 2/30, P 〈 0.05 ）. [ Conclusion] 2.5 mg levobupivacaine ＋ 20 μg fentanyl （2 mL） in subarachnoid and 0.1% levobupivacaine ＋ 1 μ/mL fentanyl with 12 mL/h in epidural is the optimal for walkable labor analgesia.

关 键 词：左旋布比卡因 分娩镇痛 硬膜外麻醉 

分 类 号：R614[医药卫生—麻醉学]